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Table 1 Summary of Study Findings

From: Delirium and other neuropsychiatric manifestations of COVID-19 infection in people with preexisting psychiatric disorders: a systematic review

ID

Country

Sample size (n)

Case# Diagnosis

Age

Sex

Description of neuropsychiatric outcomes

Disposition

GRADE

Beach 2020

United States

n = 4

(1) AUD—remitted, NCD

76 years

Female

Admitted with aggression, paranoia, alogia, and abulia. On examination had myoclonus, increased tone, and palmomental reflex. She was febrile with elevated CRP and bibasilar opacity on CXR. She was COVID positive on PCR. Head CT was nil acute and MR, EEG, LP were not done. She was trialed on olanzapine and haloperidol for management with poor effect. Switched to chlorpromazine and clonidine patch

Palliative

Very low quality

(2) AUD—remitted, NCD

70 years

Male

Admitted with aggression, staring, alogia, and abulia. On examination had cogwheel rigidity and myoclonus. An EEG showed diffuse slowing and generalized discharges and head CT was nil acute. He was COVID positive on PCR. Lorazepam was trialed for query catatonia with poor effect. His aggression and delirium were managed with physical restraints and valproic acid

Improved

(3) Schizophrenia

68 years

Male

Admitted with a fall causing subdural hematoma (seen on head CT), UTI, AKI, and hypercalcemia. He was COVID positive on PCR. His longstanding clozapine and lithium were held, after which he developed agitation, alogia, abulia, and disorientation. He had mild tardive dyskinesia on examination. Delirium was managed with physical restraints and slow reintroduction of antipsychotics

Improved

(4) MDD with psychosis, NCD

87 years

Female

Admitted with agitation, disorientation, and slurred speech. On examination she had myoclonus. She was tachycardic and had elevated CRP and was COVID positive on PCR. Delirium was initially managed with physical restraints and haloperidol, and later with quetiapine

Deceased

Martinotti

2020

Italy

n = 6

(5) MDD

61 years

Male

Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose-ICDSC score 6, post-dose score 2

NR

Very low quality

(6) MDD with psychosis

60 years

Male

Admitted with mild COVID pneumonia and fever. Developed hyperactive delirium, delusions of guilt, and suicidal ideation. Delirium managed with Abilify IM. Pre-dose ICDSC score 4, post-dose score 2

NR

(7) BD

58 years

Male

Admitted with COVID pneumonia requiring MV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose 2

Recovered

(8) MDD

64 years

Male

Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose score 2

NR

(9) BD

67 years

Male

Admitted with COVID pneumonia requiring NIMV. Hyperactive delirium managed with Abilify IM. Pre-dose ICDSC score 5, post-dose score 2

NR

(10) GAD

71 years

Male

Admitted with COVID pneumonia requiring NIMV. Developed hyperactive delirium and persecutory delusions. Delirium managed with Abilify IM. Pre-dose ICDSC score 6, post-dose score 0

Recovered

Palomar-Ciria

2020

Spain

n = 1

(11) Schizophrenia

65 years

Male

Admitted with 20-day history of bizarre behavior and incoherent speech, as well as new aggression, insomnia, echolalia, and disorientation. Head MRI was performed because of abulia, showing findings of encephalopathy. He had COVID positive antibodies but a negative PCR. He was managed with melatonin, haloperidol, and amisulpride

Improved

Very low quality

Suwan-wongse

2020

United States

n = 2

(12) BD

67 years

Female.

Admitted with disorientation, incoherent speech, AKI, and lithium toxicity (2.3 mmol/L). She was febrile and had bilateral infiltrates on CXR. She was COVID positive on PCR. Her lithium toxicity was managed with fluid resuscitation

Deceased

Very low quality

(13) ADHD, ASD, BD

18 years

Male.

Admitted with altered consciousness, AKI, and lithium toxicity (2.6 mmol/L). He was febrile and tachycardic. His CXR was normal and he was COVID positive on PCR. He was managed conservatively with fluid resuscitation and cessation of lithium with plan to restart as an outpatient

Recovered

  1. AKI Acute kidney injury, AUD alcohol use disorder, ADHD attention deficit hyperactive disorder, ASD autism spectrum disorder, BD bipolar disorder, CRP C-reactive protein, CXR chest X-ray, CT computed tomography, EEG electroencephalogram, GAD generalized anxiety disorder, ICDSC intensive care delirium screening checklist, IM intramuscular, LP lumbar puncture, MRI magnetic resonance imaging, MDD major depressive disorder, MV mechanical ventilation, NCD neurocognitive disorder, NIMV noninvasive mechanical ventilation, NR not reported, PCR polymerase chain reaction, UTI urinary tract infection